Detection of root fractures in glass fiber and metal cast dowel-restored teeth: Accuracy of Computed Tomography vs Digital Radiography

João Batista Souza,Cecília Pedroso Turssi,Francine Kühl Panzarella,Marlene Tavares de Lima Rezende,Marjorie Fonseca Da Cunha,José Luiz Cintra Junqueira

doi:10.15448/1980-6523.2016.1.16735

João Batista Souza, Cecília Pedroso Turssi + Show 4 more

Open Access

https://doi.org/10.15448/1980-6523.2016.1.16735

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Abstract

Objective: Detection of root fractures in dowel-restored teeth is challenging. Even though cone-beam computed tomography (CBCT) has shown higher sensitivity than intraoral radiography, artifacts may be generated in the presence of intraradicular posts. This study assessed the accuracy and reproducibility of CBCT and digital radiography (DR) in detecting root fractures in teeth restored with metal cast dowel and core (MCDC) or glass fiber dowel and resin composite core (GFDRCC). An additional aim was to evaluate the presence of beam hardening artifacts in CBCTs, especially in teeth restored with glass fiber dowel.Methods: Roots of bovine incisors were endodontically prepared, filled, sealed and randomly divided into two groups to receive MCCDC or GFDRCC (n=15). CBCTs and DRs were obtained prior to and after fracture induction.Results: CBCT were more accurate than DR in detecting root fractures in dowel-restored teeth. Beam hardening was observed in 100% of CBCT obtained from teeth restored with MCDC and in 93% of those in which GFDRCC had been used. Inter-observer agreement was moderate for both CBCT and DR images.Conclusion: Regardless of the dowel type, even though beam hardening had been observed in virtually all dowel-restored teeth, CBCT was the most accurate diagnostic tool in detecting root fractures.

Highlights

Morphofunctional and esthetic recovery of endodontically treated teeth with extensive loss of crown structure require intraradicular posts to retain the coronal restoration [1]
Beam hardening was observed in 100% of cone beam computed tomography (CBCT) obtained from teeth restored with metal cast dowel and core (MCDC) and in 93% of those in which glass fiber dowel and resin composite core (GFDRCC) had been used
Conclusão: Independentemente do tipo de retentor, embora o artefato beam hardening tenha sido observado virtualmente em todos os dentes com retentores, a tomografia computadorizada de feixe cônico (TCFC) foi a ferramenta com maior acurácia no diagnóstico de fraturas radiculares

Summary

Introduction

Morphofunctional and esthetic recovery of endodontically treated teeth with extensive loss of crown structure require intraradicular posts to retain the coronal restoration [1]. The radiological imaging armamentarium to aid in root fracture detection includes intraoral film or digital radiograph and cone beam computed tomography (CBCT) [5]. Radiographic examinations represent the primary imaging diagnostic method used in patients with suspected root fracture, superimposition of overlying and adjacent structures and beam direction, that is not exactly aligned with, limit the accuracy of intraoral radiographies [5,6]. Three dimensional images, as those obtained by CBCT, could allow visualization of the fracture line from different angles and orientations by evaluation of high-resolution cross sections [7,8]. CBCT images provide high contrast in comparison with those obtained with conventional 2D projections [9]

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